PROJECT SUMMARY The goal for obtaining a K-award is to acquire relevant training, practical experience, and knowledge to become an independent investigator in diabetes prevention research among culturally diverse reproductive age women and their families. Key objectives of the career development plan are to gain experience in (1) developing and conducting behavioral interventions and randomized controlled trials; (2) diabetes prevention research; and (3) establishing a record of publications. The proposed study is aligned with these objectives. Overweight and obesity during pregnancy are associated with major adverse health outcomes, including gestational diabetes mellitus (GDM), leading to increased maternal and neonatal morbidity and mortality. Women with a history of GDM have an increased risk of developing type 2 diabetes mellitus (T2DM) after pregnancy. Results from two pilot studies in a rural region of Kansas showed an alarming number of high-risk pregnancies complicated by GDM. Three quarters of pregnant women were overweight/obese, did not exercise, and had a family history of diabetes. Half of respondents were Hispanic of low socio-economic status. Further, women had limited access to health promotion programs and breastfeeding services. Given the need for health behavior change, it is worthwhile to test the use of an intervention. Evidence supports use of the Diabetes Prevention Program (DPP) in reducing postpartum weight. Recent findings also show that longer duration of breastfeeding is associated with lowering T2DM incidence after pregnancy. However, no studies have addressed the role of intensive breastfeeding support combined with an efficacious weight loss program to reduce postpartum weight, thereby reducing progression to T2DM. Thus, with the proposed randomized controlled trial, we seek to determine the feasibility and efficacy of a combined breastfeeding, DPP-based program in a cohort of overweight/obese women to be followed during pregnancy through 6 months postpartum. Our trial will have three study arms: DPP plus breastfeeding (Tx1); DPP Only (Tx2); and Usual Care (Tx3). We aim to (1) test the efficacy of Tx1 to improve 6 month postpartum weight loss among women with a BMI ?25, (2) test the efficacy of Tx1 to improve 6 month postpartum mean blood glucose (HbA1c) and mean arterial blood pressure among women with a BMI ?25, and (3) test the efficacy of Tx1 to increase breastfeeding through 6 months postpartum among women with a BMI ?25. Successful project completion will provide strategies to reduce diabetes risk factors during and after pregnancy. Findings from this pilot RCT will be used for an R01 involving a larger sample of ethnically and racially diverse rural pregnant Kansas women and children to assess if a combined breastfeeding, DPP-based program reduces maternal risk for diabetes and impedes the cycle of obesity as a diabetes risk factor.